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Vertigo

Five Physician Scientists and the Quest for a Cure

Robert W. Baloh, MD

Covers development of medical science over the past century and a half, includeing the search for and discovery of a simple cure for vertigo;

Includes historical data cultivated through detailed interviews with family members and colleagues of key investigators;

Includes historical documents previously not available in the English language;

Illustrated with 55 key historical sketches and portraits.

Vertigo

Five Physician Scientists and the Quest for a Cure

Robert W. Baloh, MD

Description

Benign paroxysmal positional vertigo (BPPV), the most common cause of vertigo, affects one in five people at some point during their lifetime, triggering the sudden feeling like one is moving or spinning when perfectly still. Early pieces of this medical puzzle appeared in the early 19th century in studies of the inner ear, yet the cause and cure for BPPV was not clearly understood until the late 20th century and it took a few more decades before this simple cure was accepted.

Vertigo: Five Physician Scientists and the Quest for a Cure follows this centuries long trek. The book follows the key discoveries made by Prosper Meniere (1799-1862) who first recognized that vertigo could originate from the inner ear, Josef Breuer (1842-1925) who conducted groundbreaking research on the inner ear during his evenings at home after he spent his days working in a busy private medical practice, Robert Barany (1876-1936) who received the Nobel Prize for his early work on the inner ear, Charles Hallpike (1900-1979) who showed that BPPV originates from the inner ear, and Harold Schuknecht (1917-1996) who provided key observations on the mechanism of BPPV.

Dr. Robert W. Baloh spins together a fascinating history using detailed interviews from those close to the key investigators and historical documents previously unavailable in the English language to provide a historical approach to understanding the vestibular system and with it a better understanding of vertigo itself.

Robert W. Baloh, MD

Table of Contents

Section 1: Prosper Ménière (1799-1862)Chapter 2. Ménière recognizes that vertigo can originate from the inner earWhat was known about the inner ear in the mid 19th century?First hint that the semicircular canals may be related to balanceMénière presents his findings in 1861The first recorded case of Ménière's disease?More evidence that vertigo can originate for the inner earInconsistencies in Ménière's description of the young girl with vertigoTreatments for vertigo in mid 19th centuryMénière 's comments trigger heated debateChapter 3. Ménière, a man of many interestsMénière's academic careerMénière balances academic, patient and family activitiesMénière's every day lifeMénière's role in French society

Section 2: Josef Breuer (1842-1925)Chapter 4. Breuer discovers how the balance portion of the inner ear worksEye movements and the semicircular canalsThe gravity sensing otolith organsEvolutionary development of the inner earMach and his psychophysical experimentsBreuer and Mach work together to defend their theoryCrum-Brown, the model makerWho contributed most to our current understanding of the vestibular system?Chapter 5. Breuer, the Renaissance man Upbringing and formative years Breuer's medical trainingBreuer chooses private practice over academic medicineBreuer, the family doctorChapter 6. Breuer's experiments on the semicircular canals and otolith organsStudies on the semicircular canalsEwald's lawsThe Breuer-Von Cyon feudStudies on the otolith organsOverview of the inner ear sensory receptorsChapter 7. Breuer's contributions to psychiatry and philosophy Freud's early work in neuroanatomyAnna O. and the beginnings of psychoanalysisBreuer and Freud and "Studies in Hysteria"The friendship between Breuer and Freud dissolvesBreuer's philosophical beliefsThe final years

Section 3: Robert Bárány (1876-1936)Chapter 8. Politzer's otology clinic and the discovery of the caloric testPolitzer maneuverTeaching in Politzer's clinicRobert Bárány joins Politzer's clinicBárány discovers the caloric testChapter 9. Bárány's formative years and the conflict in Politzer's clinicBárány's medical trainingSource of conflict in Politzer's clinicAccusations against Barany Chapter 10. The war years and Bárány's decision to leave Vienna Bárány receives the 1914 Nobel Prize in MedicineFormal charges against BárányNobel committee responseQuestions regarding Bárány's caloric theoryChapter 11. Bárány 's test battery and the first description of BPPVRomberg testPastpointing testBárány's syndromeFirst description of benign paroxysmal positional vertigo (BPPV)Chapter 12. Bárány 's life in Uppsala and his work with Lorente de NóThe brain and the neuronal theoryLorente de Nó and Bárány in SpainLorente de Nó works on central vestibular pathways with BárányBárány's final years

Section 4: Charles Hallpike (1900-1979)Chapter 13. Hallpike and the pathology of Ménière's diseaseToynebee and early efforts to study pathology of the inner earWittmaack and his new technique for preparing temporal bonesWorld-wide interest in Wittmaack's techniqueHallpike and Cairns report on the pathology of Ménière 's syndromePossible causes of Ménière's syndromeYamakawa also describes the pathology of Ménière's syndromeChapter 14. Hallpike's formative yearsThe Indian connectionEarly education and dealing with Legg-Perthes diseaseMedical trainingPersonal lifeHallpike the inventorAppointment at Queen SquareHallpike's colleagues at Queen SquareWar yearsQueen Square neurotology clinicChapter 15. Hallpike's caloric testPreparing the waterHallpike's caloric chartMeaning of a Directional PreponderanceImportance of tonic signals originating from the inner earsControversy regarding the affect of cortical lesionsChapter 16. Hallpike defines the syndrome of BPPVClinical features of BPPVConfusion regarding the direction of the positional nystagmusStrong evidence for an inner ear originPathology of BPPVFinal years

Section 5: Harold Schuknecht (1917-1996)Chapter 17. Schuknecht and his breakthrough on BPPVJohn Lindsay and University of Chicago otology clinicSchuknecht begins his residency at the University of ChicagoSchuknecht's formative yearsSchuknecht becomes interested in BPPVSearch for the cause of BPPVSchuknecht suggests a new mechanism for BPPVChapter 18. Schuknecht's temporal bone bank in BostonMore temporal bone specimens from patients with BPPVThe cupulolithiasis theorySchuknecht was not the first to propose the cupulolithiasis theoryA key question-which way does the cupula deviate?How to explain the stereotypical nystagmusProblems with the cupulolithiais theoryChapter 19. Schuknecht's crusade against myths in otologySurgical treatments of Ménière's diseaseViral neurolabyrinthitisQuestionable surgical proceduresThe final years

Section 6: The pieces of the puzzle come togetherChapter 20. Semont and Epley maneuversTreatments based on the cupulolithiasis theorySemont's maneuverCupulolithiasis vs. canalithiasisEpley 's maneuverVisualization of the free floating otolith debriChapter 21. Evolution of treatment maneuvers for BPPV Epley's maneuverSemont's maneuverFeatures shared by the maneuversVariations on the themeHorizontal canal BPPV Chapter 22. Summary and Future DirectionsDifficulties facing early investigatorsUnanswered questionsCan patients do the maneuvers on their own?

Glossary

Vertigo

Five Physician Scientists and the Quest for a Cure

Robert W. Baloh, MD

Author Information

Robert W. Baloh, MD is a professor of Neurology and Head and Neck Surgery at UCLA who has written more than 300 research articles and several textbooks focusing on the vestibular system. His interest in the history of Neurotology dates back to a series of conversations with Raphael Lorente de Nó in the early 1970s.

Vertigo

Five Physician Scientists and the Quest for a Cure

Robert W. Baloh, MD

Reviews and Awards

"I read this book from cover to cover and found it engaging, enlightening and inspiring. It has many revealing vignettes about the personal lives of the giants in neuro-otology whose eponymous names we all recognize. Bob Baloh's story illustrates how science, and especially medicine, moves forwards, sideways, backwards and then often belatedly, forwards again. And the book points out, as always, the human failings of even our most brilliant scientific heroes; jealousy, selective memory, and an unwillingness to give up one's own theories in the face of incontrovertible opposing evidence. Lessons for us all." -David S. Zee, MD, Professor, Neuro-Visual & Vestibular Division, Departments of Neurology, Ophthalmology, Otolaryngology-Head and Neck Surgery, and Neuroscience, TheJohns Hopkins Hospital, Baltimore, MD

"A riveting account by one of the giants in the field, of how clinician-scientists, have managed over the last century to unravel the secrets of the 6th sense, the sense of motion and to apply their findings to the treatment of balance disorders to give relief to those suffering from terrifying vertigo attacks. Full of fascinating information for both patients and professionals - a must read." -Michael Halmagyi, BSC, MBBS, MD, Royal Prince Alfred Hospital, Sydney, Australia

"A fascinating story of scientific discovery. Mysterious and disabling spinning sensations, psychoanalysis, pigeons, the Nobel prize, imprisonment in Russia, exile to Sweden, bouncing eyes, ear stones, and a simple but elusive cure. Dr. Baloh, a giant in the field himself, tells the story like no one else could." -Kevin Kerber, MD, Department of Neurology, University of Michigan, Ann Arbor, MI

"The sense of balance was one of the first sensory systems to emerge in evolution, but it was also the last to be discovered. In his remarkable book Vertigo - Five Physician Scientists and the Quest for a Cure Robert W. Baloh transports the reader back to the early days of vestibular discoveries, exemplified by five eminent figures in the history of neurotology. Dr. Baloh brings to life the colourful personalities that deepened our understanding of the balance system and paved the way for current vestibular diagnostics and treatment. This meticulously researched book, written by an eminent specialist in the field, will make a significant contribution to the history of vestibular science." -Gerald Wiest, MD, Professor of Neurology, Medical University Vienna, Vienna, Austria